Work load concern for clinical manager

[MissRigg]

So I am the Clinical manager for a home health agency, and I love every part of my job... the thing is I feel like my job is super overwhelming, i feel like im doing the jobs of 2 people. I'm really just looking for advice on if this is normal and if its not, how can I make things better?

So, Our agency averages 5-10 admissions per week, and we have about 90 patients in our census. We have one full time RN and a case manager, LPN who assists with QA review.

My Office roles include chart reviews, which I do bi-weekly if I can, the CM does half. I complete all 485s and approve the rap, and review the end of episode and review for billing, to do both those items I have to ensure all oasis and evals are completed, and add the eval orders and goals to the 485. I am the person in charge of making sure and following up with staff for documentation completion. For end of episode I ensure all orders are signed and all documentation is complete, If we need orders signed I make sure the calls are placed to pcp for orders. I am the point of contact for our staff, so when there is a problem during the Home visit I assist staff to make appropriate contact with PCP and problem solve the issue if possible. I initiate all case conferences, well most of them, and help guide staff on how to address needs or concerns for recertification. I am also the point of contact for our patients, if they have a concern or a question that is specific to their clinical care they come to me. I do not review the Oasis or Code, but these Items are not done without me providing a report to those who do this documentation, and requesting that it be completed. Since we only have one Nurse, outside of myself and an LPN I do follow up visits and SOC... I have been averaging about 10 visits a week, but for example, this week I have done 5 start of Care assessments, and it typically takes me about an hour and a half to an hour to complete that. I am new to my position, and our previous DON was awesome... but disorganized and I have had to revamp alot of our orientation process, review standards of intervention and create procedures because we did not have them...Im not done with that. I had not previous HH experience before this

I love my job, i love making visits and i love how much i can help patients.... Alot of my patients tell their therapist that they feel so much more confident in their disease management after my discharge, and our therapist are always thanking me and complementing our agency on the nursing follow up provided (I get the feeling that in other agencies the Nurse is not as heavily involved in care, or doesn't focus on patient needs as heavily as we do) In some cases I will follow up with patients - pcps and case managers that are not personally seen by myself to re-inforce teaching or assist with medicare guideline education and plan of care information.

But I am so crazy over whelmed... I feel like I'm always making a compromise about what important this is most important, and i keep asking to hire another nurse on, but i feel like the administration is stalling

is this normal? what should I do?

[Libby1987]

You sound like you're at either start up or trying to rebuild an agency that never fully launched?

How many new admissions does that average out per month? 30 or 40?

We run anywhere 80 - 100/month, our census is 130ish and we have 6 FT case and 3 perdiem nurses, an office nurse for 485/oasis reviews, a FT coder, a DCS and a nurse administrator. We have a clerical position for tracking and auditing orders. We sound pretty top heavy compared to you but we are very busy.

How knowledgeable and independent is your LPN with disease mgmt?

Is she primarily task oriented?

What's the availability of experienced LPNs in your area?

An aside, it would be beneficial all around if LPN programs focused/encouraged disease mgmt prepared nurses as that's the direction everything is going. But my experience has been task oriented i.e. Cath changes and basic wound care, which is not the burden we need lifted.

[MissRigg]

Our agency started in 2014 butt there have been some pretty significant changes made since December of 2016.

Rdio end left the company suddenly and I was promoted to a position that encompassed most of what she was responsible for. Our agency went to electronic medical records which means that our policy and procedure needs to be updated. And our patient census has increased.

The LPN case manager who works with me is very goal oriented and has been a nurse for 30 years so I trust her clinical skills but I don't trust her to make decisions regarding the care planning process or evaluation of a patient's needs, so there are a few things in the office that I feel I cannot ask her to do for me.

We are averaging between 30 and 40 patients a month

[oceanblue52]

I'm pretty new to home health and nursing so I don't have any administrative advice to offer, except to say that is sounds unmanageable :-( One thing I am learning though from my training and from other colleagues in HH is that not having adequate coverage for the office end of things leads to big problems with quality control and standardized documentation, which can cause even worse problems for state audits and ultimately end in huge fines. Wondering if your agency has thought this through having only been around a few years.

After reading over your job duties I would suggest at the very least that you advocate for hiring another part-time nurse to do re-visits and SOC. Those take a substantial amount of time on their own without you having to run to and from the office. And if you are paying per visit then I would think the benefits outweigh the costs of the additional wage pay. Maybe start timing how long each of your duties are (QAs of charts can be very time consuming), and then lay out exactly what you can and cannot get done in a typical day. If admin still won't budge, might be time to dust of your resume :-/